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Caitlin Heffernan’s threshold for calling in sick is so high she has to be physically unable to leave her bed before she’ll email her boss.

So when she got a cold in June, she went in anyway.

“All my coworkers were saying you don’t look so great, you don’t sound so great. Maybe you should go home,” said Heffernan, 24, an account co-ordinator with a Toronto public relations firm. “It took . . . everyone at work validating that it was OK for me to leave and then I did actually go home.”

With the headline-grabbing news that Democratic presidential candidate Hillary Clinton is sick with pneumonia, that she didn’t publicly reveal her illness for two days and that she attended events while sick, a twofold conversation is opening up about the stigma attached to taking sick days and the judgment heaped on those who refuse to take them. Women, in particular, may feel more pressure to work while sick, says a psychologist.

“We know that people, under certain circumstances, might think we’re troopers if we show up at work despite the fact that we have an acute or chronic illness,” said Gary Johns, an adjunct professor at the University of British Columbia’s Sauder School of Business and a professor of management, emeritus at Concordia University. “You’re seen as a good organizational citizen if you go the extra mile.”

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This habit of showing up to work sick is called “presenteeism,” said Johns, which is the opposite of absenteeism, when people don’t come to work. Presenteeism may be motivated by factors including job insecurity, fear of loss of income, heavy workload, a desire to show your face even if you can’t do meaningful work, understaffing and time pressure at work, he said.

But presenteeism can also stem from a general desire to do the job a person loves, which he suspects is in part why Clinton kept working.

There’s also the other reality: she has no alternate.

“The candidate has to campaign for themselves. She can’t have someone fill in for her,” said Laura Cavanagh, co-ordinator of the behavioural sciences program at Seneca College.

Even if you’re not running for president, some workers feel like there is no one else who can do their job or they worry that work will pile up without them, said Cavanagh. Instead of taking a day off to recover, they’d rather show up and suffer in the short term, avoiding getting swamped with work in the long term, she said.

Women in particular might be more inclined to work through sick because of other responsibilities, she said.

“Women still take on the bulk of the household activities or the child care activities,” said Cavanagh. “You know you’re going to have to miss work for those things. . . so you don’t want to rack up sick days (before you need them).”

Human resources experts say policies vary but some companies allow employees to use sick days to take care of kids.

There’s also a phenomenon called “stereotype threat” — the fear that people will use your behaviour as an individual to confirm a negative stereotype about a group of people, often affecting women and minorities — which may influence a woman’s decision to work while sick, she said.

“If, as a woman, you have absorbed the societal message that women are less capable than men, you may fear that calling in sick will not only reflect poorly on you as an individual. . . but that it will reflect poorly on your entire gender,” said Cavanagh. “We are worried that this action will be used not only to judge us as individuals. . . but to judge women as a whole — for example, women have too many competing priorities, women can’t focus on work.”

However, there’s little concrete evidence showing that sick women go to work more often than sick men. In one meta-analysis conducted by Johns and published in the Journal of Occupational Health Psychology, he found that women were only slightly more inclined than men to come to work when sick.

As for why stigma exists around taking sick days, Cavanagh points to “attribution bias,” a cognitive bias we use to navigate the world. Attribution bias means that we evaluate someone else’s character based off incidents we witness, but for ourselves, we don’t believe the incidents reflect who we are but are instead due to circumstances.

For instance, when someone else shows up late to work, we think that reflects badly on their character, whereas when we show up late, we point to situational factors that caused our lateness, such as traffic, she said.

Attribution bias can have worse consequences for new employees, she said.

“If you’re new and you don’t have that trust capital built up. . . for sure people are going to assume (missing work) is a reflection of your character or personality,” Cavanagh said.

And for those who aren’t lucky enough to get paid sick days, along with potential harm to reputation comes there will be financial loss. Under Ontario’s Employment Standards Act, there is no requirement for employers to pay employees when they are sick, though there is unpaid emergency sick leave for workers in a workplace with over 50 workers.

Loss of pay is a real concern, but what about infecting coworkers?

“People need to speak up and protect themselves if they feel like someone is spreading germs,” said Paula Allen a vice president with Morneau Shepell, a human resources consulting company. “You have to treat adults like adults.”

She suggests colleagues who have a good relationship with the sick person confront them about the symptoms — without assuming they’re sick, as they could have allergies. If that route’s not possible, they could speak with their boss, she said.

But for some, the boss may be the problem.

“If you fear calling in sick, then something is wrong. There’s something wrong in the relationship with your employer or the culture of the workplace,” said Allen.

She recommends people who are afraid of calling in sick sit down with a manager to talk out their concerns.

As for Heffernan, she realizes it’s not healthy to work while sick, but she can’t shake her feeling of guilt.

“There’s the personal guilt of, ‘Am I going to have a backlog of work tomorrow?’” she said. “And then. . . even though they never would, you’ll wonder if people are going to think, ‘Oh, she’s not really sick, she just wanted a day off — especially if it’s landing toward a weekend.’”

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